FTM (MASCULINIZATION SURGERY) - Thomas G. Crabtree, MD, FACS
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FTM (MASCULINIZATION SURGERY)

FTM top surgery is a term frequently applied to the surgical procedure of altering a genetic female’s chest to create a masculine appearance. This female-to-male (FTM) procedure is often one of the first gender reassignment surgeries. Breast removal, like the surgery done in a cancer-related mastectomy, removes some skin, fat, and most breast tissue. Nipples are either preserved or replanted with various techniques. Adjunct liposuction is performed to remove unwanted genetic feminine fat deposits from the chest, sternum, and armpits.

Your Consultation

Dr. Crabtree accepts referral patients from the Lavender Clinic and other supportive clinics.  After receiving the referral, our staff will set up your initial consultation. During your consultation with Dr. Crabtree, you will be counseled on exactly what to expect from your top surgery. To begin, he will examine your breast and torso skin, assess your breast tissue and evaluate your medical history, medications (including current testosterone use), prior surgeries, drug sensitives, lifestyle and habits.

 

From there, Dr. Crabtree will explain the surgical approaches and anesthesia options that are available to you. He will discuss the pros and cons of each method, and help you make an informed decision that is in your best interest and can deliver the masculine chest contour you desire. He’ll talk to you about the risks associated with surgery, and make sure you’re entirely comfortable with the process before moving forward. He and his staff will then counsel you on all the pre- and post-operative, recovery and follow-up steps you’ll need to take to ensure an optimal outcome.  You will have photos taken to submit to the insurance company for the pre-authorization process. This process can take a week to up to a month to get a decision. Dr. Crabtree can also provide you with a proposal for surgery if the insurance company denies coverage for the procedure.

FTM Top Surgery Procedures

What Is Top Surgery?

In medical terms, FTM Top Surgery is a subcutaneous mastectomy. The goal is more than just a flat chest; it should also have an aesthetically pleasing male contour, be fully sensate, and result in minimal scarring.

FTM Top Surgery

FTM Top Surgery includes: 

  • Removal of most of the breast tissue;
  • Removal of excess skin;
  • Removal of the inframammary fold.
  • Reduction and repositioning of the nipple-areolar complex.
How To Choose a Top Surgery Procedure

The choice of Top Surgery procedure is largely based on chest size and skin elasticity: 

  • Small breasts with good skin elasticity – Periareolar or Keyhole. 
  • Moderately sized chests (B cup) with good skin elasticity – Periareolar, Buttonhole Technique, Double Incision or Inverted-T.
  • Large chest or moderately-sized chest with poor elasticity – Buttonhole Technique, Double Incision or Inverted-T. 
  • Very large chests – Buttonhole Technique, Double Incision.

Note that skin with poor elasticity, often due to years of binding, can limit the surgeon’s choice of procedure and adversely affect post-operative results. 

 

Revision surgery is common: removal of “dog ears”, reduction and/or repositioning of areola, nipple reduction, additional liposuction. 

 

Special note on breast reduction mammoplasty: Some choose a breast reduction instead of a subcutaneous mastectomy, often for insurance reasons. However, note that prior breast reduction surgery may affect your options for top surgery and so should be carefully considered if top surgery is in your future. 

 

The techniques for FTM Top Surgery procedures varies between surgeons. To ensure an optimal outcome, be sure to take the time to discuss with your surgeon the specifics of the methods he or she will be using for your Top Surgery, such as size and placement of areola, nipples and incisions. 

 

Your surgeon will provide you with instructions about post-operative care and healing time. It’s important to follow your surgeon’s recommendations, otherwise you could their nullify policies on surgery revisions and liability. For more information about how to take care of your Top Surgery scars, see the guide to surgery scar care.

 

The surgical approach used will have been decided during your initial consultation and will depend, in part, on the size of your breasts. The first option available is the “keyhole” procedure, which is often used for people who would wear a size “A” or a small size “B” bra cup. With this approach, Dr. Crabtree will make an incision along the border of your areola, removing breast tissue through that opening. He will not remove extra skin or resize/reposition your nipple and areola, and your nipple sensation will usually be preserved.

 

A “double incision” top surgery is the approach that is most often used for large chested patients. It involves creating an incision along the lower border of the pectoralis muscle and around the nipple. Through those openings, excess breast tissue is removed and the nipple-areola complex is reshaped and repositioned. In addition, liposuction may be performed as needed. This is a terrific approach because it delivers an excellent masculine contour. However, the primary disadvantage is the fact that nipple sensation is usually lost.

 

The final approach is the “periareolar” technique, which is recommended for patients with small to medium breasts, large areolas and minimal excess skin. To perform this procedure, Dr. Crabtree will make an incision around the areola. Through that opening, he will remove the excess breast and fatty tissue, along with the remaining skin. He will then suture the area to tighten your skin around your newly positioned areolas.

 

Your breast masculinization procedure generally takes about three hours depending on the procedures planned and will be performed under general anesthesia administered by a Board-Certified Anesthesiologist or a Board-Certified Nurse Anesthetist at Windward Surgical Facility in Kailua, Hawaii.

  • Removal of most of the breast tissue;
  • Removal of excess skin;
  • Removal of the inframammary fold.
  • Reduction and repositioning of the nipple-areolar complex.

Your Recovery

Once Dr. Crabtree has completed the procedure, your incisions will be closed and dressings will be wrapped around the surgical wounds. For certain techniques he will then place drainage tubes in the area, which will need to remain in place for a few days.

 

You will be encouraged to begin walking as soon as possible after surgery, but it’s important to avoid strenuous activity until you’re fully healed. In about one week, Dr. Crabtree will have you return to his office where he will evaluate your progress. If you have drains you may need to come in earlier.

 

Throughout the initial recovery period, some discomfort in the treatment area is to be expected. The results of your surgery will be evident immediately and should continue to refine over the next several months as post-surgical swelling resolves. During your post-operative appointments, Dr. Crabtree will provide you with detailed steps that you can take throughout your individual healing process to optimize your recovery.